The use of millimeter waves in neurosurgery under electrophysiological control]

Duodenal iron absorption from food is selectively blocked to prevent iron intoxication. The prime example of pathologic increase in intestinal iron absorption is seen in patients with hemochromatosis. They suffer iron damage to the heart, liver, and other tissues resulting in premature death if the iron is not removed by vigorous phlebotomy. Examples of overcoming the intestinal barrier to iron are alcohol consumption, vitamin preparations with vitamin C, and iron consumed by individuals without anemia. Endogenous generation of excess iron by hemolysis, owing to abnormal hemoglobin or many transfusions, are not controlled by the intestinal barrier.     

The efficacy of Augmentin in suppurative complications in neurosurgery]

The results of clinical and laboratory studies on the use of augmentin in severe purulent complications after neurosurgical operations are presented. The laboratory studies carried out with the use of an automatic system Cobas Bact (Roch) showed that the numbers of the augmentin resistant strains of Staphylococcus and Enterobacteriaceae among the pathogens were 47 and an average of 64.5%, respectively. Gram-negative bacteria resistant to augmentin were 1.5 to 2 times less frequent than those resistant to amoxycillin. Still, they were much more frequent than those resistant to cefotaxime and ceftriaxone. Clinical efficacy of augmentin was studied in treatment of 39 patients with various affections of the brain such as tumors, trauma, vascular malformations and inflammatory processes. The postoperative complications were represented by meningitis, pneumonia, sepsis and their associations. The use of augmentin in the severe intra- and extracranial complications was favourable in 82.1% of the cases.     

Research in neurosurgery

We have measured the levels of glucose and sugar alcohols in the lens epithelium of 24 non-diabetic and 21 diabetic patients undergoing extracapsular cataract extraction for age-related cataract. Lens status was assessed preoperatively according to the Lens Opacities Classification System II. In comparison to non-diabetics, the lens epithelia of diabetic patients have increased levels of glucose and sorbitol, and lower content of myo-inositol. Both myo-inositol decrease and sorbitol accumulation are strictly related to the fasting blood sugar level. No correlation or trend was detected in diabetic subjects between myo-inositol or sorbitol level and cataract type. In non-diabetic patients nuclear opacification was associated with a significant increase of myo-inositol level in lens epithelium.     

New techniques in neurosurgery

Society demands for exactness and low complication rates of surgical treatment are high. Surgical training in the apprentice manner has been significantly reduced in Denmark since 1981 and e.g. the ability to visualize in three dimensions among younger neurosurgeons has diminished. Computer technology now makes it possible to create 3-D images that with incorporation of functionality leads to a faster and better understanding of neuroanatomy. In addition--for the sake of precision--true robotic instrumentation and navigational instruments have been introduced. The technological investments are compensated by reduced costs due to operative complications. A prerequisite for these developments are a close collaboration between medical doctors and engineers, keeping the respect for humanity intact. A survey of developmental areas in the neurosurgical techniques of today is given.     

Technical adjuncts in neurosurgery

Modifications of several surgical adjuncts are presented: a balanced microscope stand with mouthpiece and hand controls, a piston release operating stool, a support device for resting the surgeon's arms, a table mounted arm with coupling head for attaching self-retaining brain retractors, fish hook retractors, suction tubes, bipolar forceps, aneurysm clips and mobile tip mirrors. Although many of these changes are minor, they considerably facilitate microneurosurgical procedures.     

Laser-Doppler flowmetry in neurosurgery

It is theorized that persons with strong sense of coherence are likely to define an event as less stressful and be able to manage a problem more successfully than those with weak sense of coherence. The study investigated the relationship among coherence and personal and environmental concerns, appraisal of threat, emotional distress, and high-risk behaviors in minority women at risk for human immunodeficiency (HIV) infection. As predicted, a significant negative relationship was seen between level of coherence and concerns. Moreover, women strong in coherence reported less negative appraisals of threat, less emotional distress, and fewer high-risk behaviors than those with weak coherence. Results of tests of a path model investigating the impact of coherence and appraisal on distress and risk revealed coherence to be significantly and negatively associated with appraisal, distress, and risk, both directly and indirectly through its association with appraisal. The path model accounted for 45% of the variance in distress, 10% of the variance in appraisal, and 4% of risk behavior. Continuing investigation of factors such as coherence that can lessen the seriousness of environmental stressors is imperative as it relates to women at risk for HIV infection.     

Tobacco use disorder]

PURPOSE: To compare first- and fourth-year medical students' opinions about primary care practice. METHOD: A cross-sectional survey was made of medical students at New York Medical College (NYMC) and East Carolina University School of Medicine (ECUSOM) over three years (1993-94, 1994-95, and 1995-96). Three consecutive classes of first-year students from both schools (n = 807), two consecutive classes of fourth-year NYMC students (n = 373), and three consecutive classes of fourth-year ECUSOM students (n = 221) were given a self-administered questionnaire about professional aspects of primary care practice. Responses to ten items about primary care practice were the independent variables in a logistic regression analysis. Career choice, categorized as primary care or non-primary care, was the dependent variable. Independent, two-tailed t-tests were employed to compare the responses of the first-year students interested in primary care careers with those of the fourth-year students interested in primary care careers. RESULTS: In all, 639 (79%) of the first-year students and 396 (67%) of the fourth-year students returned completed questionnaires. The first-year students interested in primary care careers were significantly more likely to believe that primary care practice has more prestige, has more intellectual stimulation, needs a large knowledge base, and involves work that is more important than that of non-primary care physicians, and were significantly more likely to disagree with the assertion that in primary care practice, physicians have more control over their working hours. With one exception (prestige of primary care practice), all these independent variables were significant for the fourth-year students as well. The comparison of the first- and fourth-year students indicated that the fourth-year students were significantly more likely to believe that primary care practice has more intellectual stimulation, needs a large knowledge base, and requires knowledge that non-primary care practice may not; they were also significantly more likely to disagree with the assertions that primary care practice is adequately compensated, has more prestige, and allows more control over working hours. CONCLUSION: It appears that students' positive perceptions about primary care practice may change as realistic perceptions about the professional demands on primary care physicians develop during medical school.     

Use of intraoperative ultrasound in neurosurgery

Intraoperative ultrasound (US) is a device which is a great help to neurosurgeon in intracerebral lesions localization, in the definition of inner tumors structure, in its relation to the surrounding structures, as well as during stereotaxic operations. We report our experiences with US in more than 500 operations. Its maximum usage is during gliomas and metastases operations because of their subcortical localization. Choosing this optimal approach to the tumor, the surrounding brain is minimally damaged. Using modern devices we are able to distinguish edema from infiltrative gliomas, which was not possible using former devices (both edema and gliomas are hyperechoic). In vascular neurosurgery we use US mostly in the localization of small arteriovenous malformations (AVMs). In pediatric neurosurgery the usage is very often in drainage operations for ventricular catheter placement control. The main US shortage is lower image resolution, and the basic advantage is real time imaging. It enables our prompt intervention in every unfavorable situation.     

What''s new in pediatric neurosurgery

During the past year, there have been some significant papers dealing with pediatric neurosurgical problems. These papers deal with arteriovenous malformations, spinal cord injury, brain tumors and hydrocephalus. The papers are summarized in the following review.     

Dural tenting sutures in pediatric neurosurgery

Dural tenting sutures were used on a selective basis in 329 consecutive cranial operations in children; 16 (4.8%) required dural tenting sutures for the control of epidural bleeding and 313 (95.2%) required no dural sutures. Dural tenting sutures were never placed for prophylaxis or to satisfy a routine. Reoperation for postoperative epidural hematoma was required in 1 child (0.3%) and that child was subsequently discovered to have hemophilia. The author concludes that there is no compelling evidence for the prophylactic use of dural tenting sutures in children.